Has the Affordable Care Act reduced coverage for elderly over a certain age?

That's not likely. If she has "good insurance" and is on Medicare, I would guess that she is on one of the supplemental plans. The cheaper plans have larger copays, the more expensive ones few to none.

All too frequently, the problem is with the coding done by the hospital, so she should should start with her insurance company and ask how to go about seeing if the hospital coding is correct.

I might add that people on Medicare often get statements from the insurance company that reflect the cost before their supplemental plan is considered. It can be horrifying. So, please have her call. She may not owe as much as she thinks.

About the fact that they didn't know if something is covered - that's scary for people. It's not the Affordable Care Act - this has been the case for years. If something isn't covered by Medicare, then it's not covered by the supplemental insurance either. And the costs - as you saw - can be incredible.I hope this isn't the case with your friend.
Warm regards,
Carol

thank you -- I will try and contact one of her children with what I found out she paid and with your information.

So she paid the $15,000? Be sure to get it submitted to her supplemental insurance. My mom kept paying bills before their secondary insurance had a chance to pay. I wound up getting over $2,000 back from a variety of doctors that she had overpaid. It took forever. Sometimes doctor's offices will hound you if the secondary insurance is slow to pay, but it's still the insurance company who should pay, not the person. And many times, the doctors agree not to bill beyond what the insurance companies (Medicare and supplemental insurance) will pay. Your explanation of benefits, or EOB from the secondary insurance should show what the patient owes if anything.

And most of the Affordable Care Act doesn't take effect until 2014. So I don't think that's what's changed, if anything has.

The ACA has no effect on Medicare. If she has regular Medicare, most people have a supplement that will pick up the deductible and copays. Unless you are like my Dad & Step-mom who cancelled their supplements as they said they couldn't afford them. (But they eat every meal at restaurants as neither cooks... another story!). If she switched to a Medicare Advantage plan (heavily advertised on tv), that disenrolls you from traditional Medicare into their plan. If the emergency room she went to is not a participating provider for that Medicare Advantage plan, she can be billed for those services. I agree, check hospital coding but also check if which type of Medicare supplement she has. If it's a MA, find out if the hospital is a participating provider. If it is a life-or-death emergency, there may be a provision for the MA to pay even if they are not a provider.

Ever answer provided additional advice that, from my experience, is well founded. Thanks for being such a great community and responding when people need advice and/or comfort.
Carol

It can take months for insurance to pay a hospital bill - a lot of times a copy of the bill from the hospital gets to the patient before insurance or medicare has paid any of the portion - it doesn't mean that is what she owes YET. Call the insurance company and ask them. My aunt made the mistake of thinking that was actually her bill for $20,000. - she pulled money out of her retirement account and paid it - turned out the above had happened, and she got a refund a few months later.

Well I don't know about any of this, as now my elderly mother-in-law, recently hospitalized and now in rehab, is getting very large bills from her care. She is 91 and has very good coverage and Medicare. It is daunting to think of what is going to come yet in bills! I am sure all of you are writing with past experience, but I am saying that from my position with these two elderly women, I see much more out of pocket expense for any medical care for elderly. It is down right scary!! And this appears to be new . . . charging the elderly and hitting their personal finances rather than insurance and medicare picking it up. Very sincerely, I hope I am wrong, wrong, wrong, but from what we are seeing, it appears changes have happened.

No - the changes might be in the way they are billing, which could be an indirect result of the ACA going into effect, but it has nothing to do with the ACA per se, as that is not affecting medicare or what medicare covers. The issue may also have to do with the hospital/facility not obtaining approvals from the insurance company prior to running the expensive tests, etc. - again - it's about how they are being done, not about ACA. Don't pay the bills unless you have been told they are services not covered by her insurance or medicare, and then question why they were even done if they weren't covered.

If she went out of network and had no prior authorization, she may get stuck with the bill. Many insurance companies have totally dropped coverage for walk-in non-hospital clinics. You said they warned her; she didn't listen to them. Call her insurance company and try to straighten it out.

She was in extreme pain, doubled over. She did not know what was wrong, so it would have been hard for her to say no tests in that condition.

It's not the ACA. Hospitals have started admitting people "for observation," which may mean that insurance doesn't pay as much of the bill. If she were an inpatient, maybe more would have been covered. There have been cases of people being held for observation and not admitted for three! whole days.

I would assume that it's a screw-up with the insurance. Please let us know how this works out.

Yes, I am aware of the observation vs. in-patient issue for insurance reasons. And that they are "observing" elderly to get away with not admitting them. Such a messed up world! Will try to follow up here when we know more.

Ellenjay, it may not be a bill at all. My daughter thought she got a bill for $6,000 and it was just a statement of coverage. Read it for her if you can.

Jinx4740 Do you know why the hospitals are admitting patients for observation rather than just straight in patient? I am curious, this just happened to my mother who was admitted for gall bladder stones and the need for surgery, instead they admitted her for observation for 3 days, the doctor then comes and says they are releasing her and she will have to live with the pain. This HMO doctor says that because Mom has been taking Warfarin and her history of heart arrhythmia, they do not want to take a chance on surgery!!!! She left the room to release my Mom and in 5 minutes a surgeon is standing at Mom's bedside telling her he can do the surgery tomorrow with no problem and he was right. I just don't get the "observation" thing as Mom's Gastroenterologist is who sent her to the hospital for surgery.

There are some tests and physical therapy that use to be covered by Medicare but it is no longer covered or has been reduced. When something like this happens the patient is suppose to be informed and they even have you sign a form stating that you realize Medicare may not cover whatever it is. If you sign it and they do it, you are saying that you agree to pay for said services. The thing is you keep saying she has "really good insurance and Medicare." That statement worries me as normally Medicare is the primary insurance, if you are no longer working. When I hear patients say things like this I get sick to my stomach as it normally means they belong to an HMO and have signed their Medicare benefits over to the HMO. When this happens, you no longer actually have Medicare, you now have an HMO, like Kaiser, Humana, Scan, etc. YOU MUST SEEK ALL CARE THROUGH THEM AND THEIR DOCTORS AND HOSPITALS, MUST, MUST, MUST!!!!!!! If you fail to do this you will be responsible for paying all charges because you did not seek care through a participating provider!!!!!!!!

Lastly NEVER PAY A BILL LIKE THIS!!!!!! UNTIL YOU HAVE CHECKED OUT WHY IT WAS NOT PAID AND IS IT BEING SUBMITTED TO A SECONDARY INSURANCE CARRIER!!!!! IF YOU PAY ANY AMOUNT OF MONEY TO A DOCTOR OR HOSPITAL, MANY OF THEM DO NOT REIMBURSE YOU AUTOMATICALLY....UNLESS YOU ASK THEM TO!!!!!!

This ticks me off to no end, but I have worked for them and let me tell you they will hold on to the money because they can. There is no law that states that they have to pay you back within any amount of time. I think this is wrong, wrong, wrong and they should be penalized for doing it, but when they see they have $100,000 sitting in their bank account that should be refunded, they don't want to and they will hold on to your money!!!!!!!! My former employer is currently sitting on a large sum of money that he refuses to refund of his own accord and has instructed his bookkeeping office to hold on to the funds unless the patient requests a refund. Most of these patients are elderly and do not even realize they have a refund coming. It is sickening!!! DO NOT PAY ANY PHYSICIAN OR HOSPITAL UNTIL YOU HAVE EXHAUSTED ALL AVENUES OF PAYMENT TO THEM. DO NOT GO OUTSIDE YOUR HMO EITHER!!!

My statements about Medicare not paying for certain tests or as much physical therapy as they use to has nothing to do with the ACA that I know of, every year Medicare cuts the amount they pay to physicians and now they have begun to cut services not just the amount they pay.

There is a problem in some places with doctors accepting patients with Medicare so you have to ask every doctor you see if they will accept Medicare, many are taking new patients due to reimbursements.

Make that "many are NOT taking new patients due to reimbursements."

It has to do with Medicare trying to save money, of course. Medicare pays less for a patient who is not "admitted." They have contractors whose job it is to make sure all admissions are truly needed. Google "observation vs admit to hospital" for a Boston Globe article from 8/24/2013.

It's complicated. I don't want Medicare to make ME pay more for my care, but I want them to cut out all the fraud and abuse from "the bad guys." I want Medicare to be available to me and my daughter, and they need to reduce the costs to ensure that. Rock and a hard place.

EllenJay - The ACA hasn't even started yet, still in application stage, so what happened with your friend has nothing to do with ACA.

As others have said, she needs to take the time to carefully review the statement to see what it is and what is expected. Almost all facilities take Medicare and Medicare reimbursement rates are set and paid the same for the specific coded procedure. Now the issue will be with the non-Medicare paid for part of her costs. If it was an out-of-region or none-participating provider, the costs could be significant. This is the same thing if you go to see a doctor or go to a clinic or hospital who is not in your health insurance groups "network". (BTW This is one of the reasons why the ACA is so very important in that for regular health insurance the out of region f***ing you get will be gone.)

The statements can be mailed with 48 hours from discharge or when a procedure was done and usually the first mailing does not include any payments from Medicare or the insurance company. So the amount will be some kinda huge. Then maybe 30 days later you get another statement that shows the anticipated insurance payment and then 60 days later another statement with credits, etc. Once Medicare has paid their negotiated rate and you get billed the balance due. If they are in-network it will be reduced and if not in network it won't be. Then there are charges that neither Medicare or insurance will pay ever.

It is not just the elderly that have these costs. You know I think that about 50% of all bankruptcy's are due to medical bills. One health problem & hospitalization can easily run 6 figures, and there are really no more Hill Burton funded hospitals out there like there used to be to provide for free care. Gosh, even C sections can run 20K. I just had a CAT scan due to 4th nerve issue and the study was 5K. Our insurance paid 80% and the rest had to be paid or debt contract signed before the procedure was done - if we did cash or debit card they took 20% off. Not everybody has 800K in their purse right now and that was just for 1 test. Now the digital imaging center closest to us, was NOT in network and if I went there then our insurance would only pay 50% of the cost. So I had to make sure they were in network even though the procedure was the same. It was up to me to find that out. ACA should limit that happening in the future.

HolyCow - I think the whole observation scenario is geared to being able to run lots of tests. Once they are admitted then isn't it the case that Medicare has a specific list of what is allowed under the admit code? And it has to go through the hospital and under Medicare's already negotiated reimbursement rate.

But if they are just on observation, then it's like being in the doc's office and so lots of lab tests, x-rays, scans, etc as there is no set limit to what can be billed. I bet a lot of the test done get run through outside vendors too. Probably some Stark Law violations in all that too. I would so like to see CMS go in heavy on Stark compliance with doc's and their lab agreements.

Jinx4740 has given invaluable information in that web link. Ask if you are staying for observation or being admitted. Do not sign anything unless it states that you are being admitted or on inpatient status or you could be stuck with the full bill unless you have part B or other health insurance cverage. It is not so much the hospital's dong, but the medicare rules that are so contradictory and unclear even to hospitals. There are too many differental governement agencies making Medicare decisions that create chaos for those on medicare.

Ellenjay, definitely not the ACA ... as igloo points out, that isn't even in effect yet, and as others have stated, it has nothing to do with medicare. Even those non-medicare subscribers whose coverage is changing under ACA won't have the changes be effective until next year. Of course that doesn't make it less of an issue for you, but at least let's not place blame where it doesn't belong.

I've been shocked at some of my own medical statements, until I notice they have not been submitted to insurance yet ... or they have submitted it but not received payment yet. Whew! When all was said and done, I didn't owe anything, or perhaps a $10 copay.

I don't know what the $15,000 charge means for your mother. I sincerely hope it turns out she owes much less than that. Please let us know. We learn from each other.

The $15,000 charge was for a woman I work for in her home. I don't want to upset her, but am not sure how to help her. At 85, she is pretty with it, but I think she paid this way too fast. I am unsure if I should say that to her, or just ask her if I can talk to one of her children about it. This would really be sticking my nose in her business, but I do think she should have waited to write that check. If her kids are aware, I would think they would have stopped that and maybe handled it for her. It is a little bit touchy situation for me that I am unsure how to handle correctly.

Maybe point out that you've just found out that some people pay before they need to and you have friends (i.e. me) who found out their parents overpaid and got a lot of money back ($2,000 in my parent's case). Ask if it would be ok to talk to one of her kids about it, to see if they might know more about how it works. If you get one of her kids involved and they need more help in understanding it, have them come here to get more help.

You're obviously a very caring person and if she's worried about paying $15k, I think she'd be thrilled at the idea she might get some of that back. Let us know if you do pursue it with her.

Thank you, I will try that approach. She is a very fearful person, so I am praying about how and when I could talk with her. It needs to be soon though!

I just met with my ins. agent today and I am so furious you really, really, don't want to hear my thoughts on this medicare issue. I can't even talk about what I have learned about OBummerCare, which has definitely affected medicare, now and next year!!!

Bren, Congress have made it known years ago of wanting to phase out social security. And then a few years later, they also want to phase out Medicare. Either that or the media got it wrong. But I don't think so. They're trying to push those in Medicare to try an alternate option. When I first heard about Obamacare, I told my father that this is bad news. Since the feds are trying to rid of Medicare, they will say that they need more funding towards Obamacare. So they will need to take that fund from somewhere. I figured that they will take it out of the Medicare and maybe also Medicaid budgets. That was my theory. I stopped following the news on it. My father has been wanting to quit his secondary insurance. I've persuaded him - every year - NOT to do this. I've told him over and over that the feds will be cutting back on the annual budget to Medicare and he really needs that secondary insurance. sigh....

I think I am calm enough now to talk about my visit with my agent. A couple of months ago I received a notice from my medicare ins. that my plan would no longer be available in 2014. My agent and I spent 4 hrs. looking for another plan. Finally found one, but all the co-pays went up, ambulance went up, in hospital co-pay per day went up, out of pocket max. pay per yr. went from $3,700 to $6,700 and the drug co-pays went up. There is absolutely no one to thank for this rip-off but our socialist pres. He is destroying our country!!!

I still don't get the whole "observation vs inpatient" thing as my mother was seeing a gerontologist for severe pain in the area of the gall bladder. We knew she had stones and had for years but it reared it's ugly head at 84 and she was in horrible pain. He sent us for ultra sound and blood work and called me and said "get your mother to the emergency room immediately, she has a severe gall bladder infection and is in need of surgery NOW. Have them call me and I will provide all the information they need." My sister and I took her and she was seen by an HMO Hospitalist doctor, even though Mom is not HMO. She was in emergency for over 6 hours and they ran all kinds of tests then decided to admit her. This hospitalist then told us they were putting her in their brand new south tower for "observation." This room was beautiful and so was the entire wing, however there was not a lot of testing or anything being done, we were waiting for the surgery to be performed. This is when the Hospitalist came and said they were releasing Mom and she would just have to live with the pain! Due to use of Warfarin and arrhythmia she was not a good risk for them to do surgery on. I was in shock and I was angry! Within 5 minutes a surgeon was standing at Mom's bedside telling us he could do the surgery the following day with no problems! It was really 5 minutes! I said great, lets do it and we did and he was right she was fine. Her arrhythmia did act up but her heart doctor was there and put her on some new meds that are working great for her. The cardiac unit that Mom was transferred to AFTER observation and surgery was horrible compared to the "Observation" room she had been in.

This was the first time this ever happened to us or that Mom was held solely for "observation" so it threw me. I do not understand why she would have ever been put into "observation" when a doctor told them she needed surgery immediately anyway!

Some of these brand new doctors that are in these HMO's scare me as I wonder just how good they really are since they do such stupid things. I feel like they cannot be trusted. Mom's private doctor retired and sold his practice to an HMO is how we became involved with these doctors anyway, now we have to find a new private practice doctor for her to see.

When the hospital sent me a questionnaire about Mom's stay, I did complain and told them what all had gone on and this doctor that was just going to release Mom and let her live with gall stone pain.

We have received some statements in the mail but everything has been covered. I was waiting for a bill to come in and getting ready to raise heck over it.... so far it has been good. Could use suggestions for finding a good private doctor for her for the future.

HolyCow I'll tell you what I did. When my parents moved up here to be near me, I took the booklet with the list of the doctors in their PPO to our hospital. I went to the general nursing floor and went to the nurses' station. I asked the nurses to point out which doctor(s) they'd recommend for their elderly parents. At first, one nurse didn't want to help (they're afraid they'll get in trouble), but another one came over and started looking and giving me feedback. Comments like, "I wouldn't take my dog to him"... stuff like that. I soon had two or three nurses going through my list. I found a great doctor for my mom and dad that way. You may find resistance (and do it when docs aren't there at the nurses' station doing their rounds) but it worked for me.

When my mom was to have a heart procedure, the cardiologist in the practice was arrogant and ignorant of the medications he gave my mom to prep for the procedure. So I asked around and took her to another doc in that practice, who we love. You can also look online at some of the ratings websites, but I think those aren't as helpful as nurses. They know what's really going on. If you need a cardiologist, then go to the hospital's heart floor, etc. Finding the right doc can make all of the difference in the world for your mom. Good luck!!

OK all, I did decide to make contact with my elderly friend's daughter at her work place. She was SO grateful for my call (concerning her mom's payment of about $15,000 in an overnight hospital stay with tests) and will be looking into it soon. Her mom obviously made the decision to pay the large bill without asking one of her children about it. Daughter I contacted gave me her own cell phone so I could call again when I notice anything I think the family should know. I feel so much better now! Thanks for all the help and encouragement. Now to keep things ok with my own parents!! Calling our insurance agent this morning.